Magnetic resonance imaging of cerebrotendinous xanthomatosis

Cerebrotendinous xanthomatosis is a rare familial sterol storage disease with accumulation of cholestanol and cholesterol particularly in xanthomas, bile and brain. Magnetic resonance imaging is a useful modality for imaging the affected tissues. It contributes to the evaluation and management of the disease.     

Parvovirus B19 infection and Diamond-Blackfan anaemia

It is the purpose of the study to report the frequency of parvovirus in children with a diagnosis of Diamond-Blackfan anaemia and to discuss the possible aetiological role of parvovirus in Diamond-Blackfan anaemia. We found parvovirus DNA in 3 of 11 bone marrow smears. Giant pronormoblasts showed low sensitivity (33%) and poor specificity (75%). The presence of giant pronormoblasts was associated with a very high myeloid: erythroid ratio, and may not be specific for parvovirus infection, but a feature of severely suppressed erythropoiesis. The three parvovirus-positive patients were the only children who experienced a remission, and who are free of medication. The seven surviving parvovirus-negative patients are all currently on steroid treatment.     

Reconciling scientific and religious discourse about madness during the age of reason: lessons for today?

Reconciling scientific and religious discourse about madness during the age of reason: lessons for today? This paper argues that the secularization of madness, during the seventeenth and eighteenth centuries, occurred as a consequence of cultural change that accompanied the social upheavals of the age. In examining the reconciliation of competing explanations for madness, from theological and empirical viewpoints, it is suggested that these paradigms were never totally separated and argued that developments during this period were a consequence of continual interaction and dialogue between these contrasting views. Furthermore, it is suggested that an understanding of these changing times can illuminate present debates surrounding mental illness.     

Brain tumors and occupational exposures in a cohort of female textile workers in Shanghai, China

OBJECTIVES： This study assessed the associations between brain tumors and specific processes and exposures among female textile workers in Shanghai, China. METHODS： A case-cohort study was conducted that was nested in a cohort of textile workers originally included in a randomized trial of breast self-examination. Incident brain tumor cases （N=114） were identified from 1989 to 1998 from a tumor and death registry operated by the Shanghai Textile Industry Bureau. A subcohort （N=3188）, representing an agestratified random sample of the entire cohort, was selected as a comparison group.     

茶碱对有呼吸窘迫综合征的极早产儿患血管运动性肾病的预防作用研究：一项随机双盲安慰剂对照试验

背景:血管运动性肾病是早产儿常见的肾功能障碍性疾患。目的:确定茶碱是否可以预防有呼吸窘迫综合征的极早产儿罹患血管运动性肾病。方法:随机双盲安慰剂对照试验,50例胎龄≤32周须辅助通气的早产儿。婴儿接受3d茶碱(1m g/kg)或安慰剂静脉注射。每天测定其24h尿量。在第2、第5及第11天,收集血样及12h尿并进行电解质、肌酐、尿素分析。结果:茶碱组患儿的第1天排尿量的组别x(s)为2.4(0.9)m l/(kg·h),显著高于安慰剂组[1.6(1.0)m l/(kg·h);P=0.023]。茶碱组少尿或无尿的发生率(5%)显著低于安慰剂组(33%)。在第一次给予茶碱/安慰剂后24h,茶碱…     

Inhibition of an anti-Pr1d cold agglutinin by citrate present in commercial red cell preservative solutions

A patient with known cold autoimmune hemolyticanemia was admitted for surgery. Routine cold agglutinin evaluations, using commercial red cells (RBCs) in modified Alsever's preservative solution, revealed a cold agglutinin titer of 4 to 16. However, using RBCs washed four times with saline, a high-titer (greater than 2000 at 4 degrees C) cold autoagglutinin was demonstrated. The cold agglutinin was shown to be an IgM kappa paraprotein with anti-Pr1d specificity. The addition of Alsever's solution to washed RBCs inhibited the cold agglutinin. Each major component of Alsever's solution (neomycin, chloramphenicol, inosine, dextrose, and citrate) was tested individually; only citrate inhibited the patient's cold agglutinin. Various compounds structurally related to citrate were tested and found to cause various degrees of inhibition. The strongest inhibition correlated with the presence of either three carboxyl groups on molecules devoid of double-bonded carbon atoms or two carboxyl groups in cis configuration. A panel of 54 cold agglutinins, including 7 with anti-Pr specificity, was analyzed. None was significantly inhibited by Alsever's solution, although one with anti-Pr2 specificity was weakly inhibited. In summary, these studies describe an anti-Pr1d cold autoagglutinin that was inhibited by citrate in RBC preservative solutions. The failure to detect such a cold agglutinin can result from not washing RBCs free of citrate before testing.     

A review of the Transitional Emergency Nurse Practitioner

Introduction

A retrospective exploratory study was conducted to (i) explore the practice patterns of a Transitional Emergency Nurse Practitioner (TENP) working across two urban Emergency Departments (ED); (ii) identify the demographic characteristics of the TENP patient cohort; and (iii) identify if TENP patients were appropriately and timely managed.

Method

The study was conducted across two hospital sites over two consecutive years for a 3-month period. Data collection occurred during the months of December through to February. TENP patients were identified by hospital electronic medical record and were then grouped into a model that included ‘Fast Track’ or ‘See and Treat’ cohort. The cohorts were then analysed for diagnostic groups, age, sex, length of stay, triage category, and re-presentations.

Results

The TENP worked a total of 600 h (Site 1 252 h; Site 2 348 h) across the study period. The TENP managed a total of 481 patients (262 Site 1; 220 Site 2) during the study period. The majority of patients (412; 84%) were managed in the ‘See and Treat’ cohort (Site 1 246, 94%; Site 2 166, 75%) and 70 patients (16%) were managed in the ‘Fast Track’ cohort (Site 1 16, 4%; Site 2 54, 25%). The median length of stay for TENP managed patients was 143 min, with 96% of patients leaving the ED in less than 8 h. There were no TENP unplanned re-presentations at either site. The TENP managed more male patients across both sites. The majority (75%) of patients the TENP managed had musculoskeletal and/or wound conditions or injuries.

Conclusion

TENP practice across the two Sydney metropolitan ED sites was similar. The model adapted for Tertiary Referral centres was appropriate for smaller urban EDs. The study supports existing evidence of timely and appropriate care being delivered by TENPs across Australian EDs. Given the work practice similarities, the study demonstrates that State and/or National standards and policies could be developed for emergency advanced practice roles.